peds gi disorders 1 test 2 Flashcards
(Hypertrophic) Pyloric stenosis causes
Incomplete maturation of nerve fibers to pylorus
Mechanical trauma from stomach contents resulting in pyloric muscle hypertrophy
Develops after birth
Associated with some genetic syndromes: Apert, Zellweger, trisomy 18
t/f Females with pyloric stenosis have a 4x greater chance of having a child with the disease
true (this was one of the first questions I asked my wife. I aint got time for that)
t/f Exposure to macrolide antibiotics (for treatment/ prophylaxis of pertussis) may increase risk.
true!
presentation of pyloric stenosis
Non-bilious emesis that becomes progressively forceful
Vomiting, intermittent to start
Anxious to feed after emesis
Projectile vomiting as disease progresses
age range for pyloric stenosis
Range: Birth- 3 months
complication of pyloric stenosis
Dehydration, depending on time to diagnosis
exam findings for pyloric stenosis
Anxious, hungry appearing
Dehydrated, malnourished – in advanced disease
Palpable pylorus (described as an “olive”)
Firm, mobile mass, olive shaped and located above and to the right of the umbilicus
Visible gastric peristalsis
Jaundice is commonly present
first line imaging for pyloric stenosis
US (Merica!) 95% sensitivity
if you don’t do an US and you do a barium upper GI exam what are you looking for
string sign- elongated pyloric channel
shoulder sign- bulge of the pyloric muscle in to the antrum
what lab finding will you see with pyloric stenosis
Met B will demonstrate a hypochloremic metabolic alkalosis
due to loss of hydrogen ions and chloride from emesis
how do you manage pyloric stenosis
Rehydration/ correction of electrolytes (may present with alkalosis secondary to vomiting)
Surgical consultation
what is celiac disease
autoimmune disease
Gluten protein sensitivity
Wheat, barley, rye, less commonly oats
what does celiac disease cause
Chronic inflammation of the small intestine
what antibody is present in celiac disease
Anti-TG2 antibodies present
what is the classic presentation of celiac disease
after the introduction of gluten containing foods:
Chronic diarrhea,
abdominal distention, irritability,
anorexia,
vomiting and poor weight gain
stops with a gluten free diet,
starts with re-introduction of gluten
what is the common (it is atypical) presentation of celiac disease
minor GI issues
low height and weight increase
anemia from iron deficiency (not responsive to iron sups) (teeners)
arthritis, bone issues
celiac disease PE findings
Bloating of the abdomen
Dental enamel hypoplasia – rare but highly specific when present
Muscle wasting
lab findings for celiac disease
IgA anti-TG2
D-AGA
steatorrhea
Hypoproteinemia
Anemia (low MCV-iron def)
(there is so much about celiac disease wtf!) what do you see on bowel biopsy
Villous atrophy with hyperplasia of the crypts
Abnormal surface epithelium
(marsh grading system)
what does the marsh grading system look at
Intraepithelial lymphocytes
Crypt hyperplasia
Villi
what is intussusception
segment of intestine telescopes into the adjoining intestinal lumen, causing bowel obstruction.
age for intussusception
children aged 3 months to 6 years of age
where does intussusception occure
Usually at ileocecal junction
hallmark of intussusception
the jelly stool (dont eat it! not smuckers)
Sausage-shaped mass
knees to chest
what is the common presentation of intussusception
paroxysms of abdominal pain with screaming and drawing up of the knees
Vomiting and diarrhea occur soon after
Bloody bowel movements with mucus appear within next 12 hours
Lethargic between paroxysms and may be febrile
Intussusception US findings
x ray findings
coil spring
lack of colonic gas
intussusception tx
Hydrostatic/ pneumatic reduction (barium or h2o)
surgical
presents between age 2-8
bright red blood on the stool or protrusion from the rectum
(red thing coming out of the butt hole)
Juvenile polyps
tx - endoscopic resection
containis all bowel layers
Most common congenital GI abnormality
Meckel’s diverticulum
what are the rules of twos for Meckel’s diverticulum
2:1 Male/ Female ratio,
usually within 2 feet of terminal ileum,
up to 2 inches in length
Meckel’s diverticulum findings
stool is brick colored or currant jelly colored
obstruction if persistent
an be the lead point for intussusception
imaging for Meckel’s diverticulum
Nuclear imaging – Meckel radionuclide scan
tx - surgical removal
Most common indication for acute abdomen surgery in children
Incidence of perforation is high in childhood, particularly in children <2 y.o.
Appendicitis
signs of Appendicitis
Anorexia
Vomiting
Pain – usually periumbilical to RLQ
Diarrhea
when does perf typically happen
36 hrs after symptom onset
imaging used for appendicitis
US
CT
appendicitis UA findings
cbc findings
few white or red blood cells
Elevated white count
CRP can be elevated
t/f preme’s have a lower chance of hernia formation
false
males also have a higher risk
age with highest risk of Incarceration (jail time baby criminal!)
under 1yo
when to refer a hernia
History of mass/ reducible mass: Elective referral
Reducible mass w/ secondary symptoms: Urgent referral
Non-reducible mass: Emergent referral
what is constipation (this is getting deep)
“Any definition of constipation is relative and depends on stool consistency, stool frequency, and difficulty in passing the stool.”
what is normal for stools
newborn:
breast feed:
formula feed:
toddler:
preschool:
Newborn: usually 4 soft or liquid stools
Breastfed: 3 soft/day
Formula fed: 2 -3 stools/day
Toddler: 1-2 formed stools/day
Preschool: 1-2 formed stools/day
common times for constipation to occur
infancy:
toddler:
school age:
Infancy: at transition to solid foods
Toddler: at transition to toilet training
School-age: at entry to school
ddx for constipation
Cystic Fibrosis – meconium plug
Hirschprung – failure to pass stool, or passage of only small amount
Hypothyroidism
tx for constipation infants
Add osmotically active carbohydrates to the formula, titrating to desired effect (soft, easy to pass stool)
fiber
glycerin suppositories for impaction
t/f Toilet training may trigger constipation
true very true
tx for toddler constipation
decrease milk
increase fiber
miralax
mineral oil
laxatives / softners
cause of constipation for school age
stool with holding
tx is same as toddler
Voluntary or involuntary passage of feces into inappropriate places at least once a month for 3 consecutive months once a chronologic or developmental age of 4 has been reached”
encopresis (ooops i crapped my pants!)
signs of encopresis
large stools that clog toilet
dirty underpants
history of uti
rectal exam findings in encopresis
x ray findings
hard stool in vault
lots of poop
encopresis tx
mineral oil or lax
bowel training
gi issues that have butt hole bleeding
intussuscepton
juvenile polyps
meckel’s diverticulum
